COVID-19 Benefits Coverage

Updates to COVID-19 coverage as Public Health Emergency (PHE) ends

Throughout the COVID-19 pandemic, we have been committed to helping you receive the care they need. With the Public Health Emergency (PHE) ending on May 11, 2023, our commitment to helping you stay healthy remains as strong as ever.

You will continue to have access to COVID-19 vaccines and testing; however, how these benefits are covered is changing starting May 12 (the day after the PHE ends).

Your Independence Blue Cross Keystone and Personal Choice plans coverage of COVID-19 related benefits after the PHE is outlined below.

Coverage for COVID-19 benefits

Vaccine and Boosters: The COVID-19 vaccine will continue to be covered as a preventive service at no cost when obtained from an in-network provider. If the vaccine is administered by an out-of-network provider, standard cost-sharing will apply. Network rules apply based on benefit design.

For employees in SPAP, CASA, and Non Represented positions, vaccinations and boosters are covered through their prescription benefits when administered at a pharmacy.  Vaccine and boosters are  not covered under the prescription plans for employees in positions represented by the PFT and Local 634. If your prescription plan does not cover these benefits, your SDP Medical coverage will reimburse you. You will be required to pay out of pocket and then submit for reimbursement under your medical benefits.

Use the HMO COVID-19 vaccine Reimbursement form or the PPO COVID-19 vaccine Reimbursement form.  You need to include an itemized bill that includes the following:

  • Name, address, and telephone number (on official bill head) of the PROVIDER rendering the service or supplying the item
  • PATIENT’S full name
  • DESCRIPTION of each service, or item supply
  • DATE AND AMOUNT CHARGED for each service, or supply
  • VACCINE BRAND AND DOSE NUMBER (see detailed instructions on the form in step 4)

Please be sure to have the provider mark “PAID IN FULL” clearly on the bill.

Please use a SEPARATE claim form for each family member.

Diagnostic testing: Copay, deductibles, and coinsurance will apply to visits when members are tested for COVID-19. Diagnostic testing for COVID-19 will be paid consistent with your health plan benefits, including benefits for in-network or out-of-network services. Testing should continue to be performed only when medically necessary.

Over-the-counter (OTC) at-home testing reimbursement: Coverage for eight free take-home OTC tests will end at the conclusion of the PHE. Per federal guidance, members with HSAs or FSAs may receive reimbursement for OTC tests. Diagnostic testing for COVID-19 continues to be covered consistent with our health plan benefits, including benefits for in-network or out-of-network services. 

Telemedicine: We continue to offer telemdicine visits through MDLIVE with no cost-sharing for
Timely filing of claims: Federal guidance required the suspension of timely filing requirements for up to one year during the PHE. Timely filing requirements will begin again 60 days after the PHE for any claim that is currently covered by the waiver of timely filing guidance.

Timely filing of claims: Federal guidance required the suspension of timely filing requirements for up to one year during the PHE. Timely filing requirements will begin again 60 days after the PHE for any claim that is currently covered by the waiver of timely filing guidance.